Depression in Children: A silent killer

Depressed children may feel that he or she is useless and does not amount to anything. Esteem issues come into play. The child feels that “nobody” understands them or knows what they are going through. Some may resort to drug abuse. Internet Photo.

It has been three years now, but the Kisitu's are still finding it hard to come to terms with the death of their only daughter, the first of only two children they had in 13 years of marriage.

The mother keeps blaming herself for the death of her child as does the father, something which has affected their marriage. None of them saw it coming.

Evelyn Kisitu was only 13 years old when she committed suicide, a fact the Kisitu's don’t want to hear at all. To them, their daughter “died” but “did not kill herself” although a post mortem report indicates so.-

According to one of Evelyn’s peers, she was a quiet girl who interacted little with others. A bright introverted girl, she was more of a recluse after school time, who seemed like she was going through a hard time at home, even though her parents provided for her every material need.

“She had nearly everything that most of us [friends] would have liked to have as children,” recalls another friend of the deceased, adding that, but she was always sad, had lost interest in activities that children of her age enjoy, and towards the time of her death, had started losing weight.

This, her friends could tell, but the parents could not until the day they found her dead in her bed after she had taken an overdose of drugs, which according to the post mortem report, were not prescribed by a doctor. She was not suffering from any illness at the time.

Although she previously had a history of autism, which is a failure to develop social abilities, language and other communication skills to the usual level during her infancy, her situation had since changed and was coping easily with her age mates at the time of her death.

“I was told only three days to her death, by my neighbour, a doctor, that my daughter could be suffering from depression. But because of our schedule we did not take it seriously since none of us had ever been diagnosed with any acute disorder,” her mother recalls.

Simply put, Evelyn succumbed to depression, a form of mental illness that is on the rise amongst children in the country due the poor standards of living, poverty and school curriculum load, among other social and societal afflictions.

However, unlike other perceptible and fairly easily treatable illnesses or disorders that children suffer from, depression is rising rather fast because parents do not take the time to monitor their children’s everyday growth while on the other hand, little education about the mental disorder has been offered.

Last year, during the World Mental Health Day back in November, the principal focus was put on the rising figures of depression in children feasibly put at 70 per cent because in an environment where the illness has not been given attention, aggregate statistics can hardly be arrived at.

What is depression?
According to the Diagnostic Statistical Manual for Mental Health, an online medical journal, depression is a mood disorder characterised by either sadness or loss of interest in pleasurable activities accompanied by at least four additional symptoms drawn from a list which may include changes in appetite or weight, or in sleep and psychomotor activity, decreased energy, feelings of worthlessness or guilt, difficulty in thinking, concentrating or making decisions, recurrent thoughts of death or suicidal ideation/ plans/ attempts.

In children and adolescents, one’s mood may seem more irritable or cranky as opposed to being sad or of a depressed nature. The child may also feel that life is hopeless, could be discouraged or “down in the dumps”.

In noting the causes of depression, the journal indicates that children are faced by different psychosocial stressors within the environment. However, from a bio psychosocial perspective, these psychosocial stressors could be biological, psychological and social.

It states: “Every child has the resources necessary to deal with these stressors. A breakdown in these resources, say failure for one to cope adequately, results into depression or depressive symptoms. Stressors include death of a parent, divorce, poor grades, and bullying, low self-esteem, among others.

Dr Catherine Abbo, a child and adolescent psychiatrist, refers to depression as persistent sadness and lack of enjoyments of life whose diagnostic key aspects include persistent feeling of low moods, loss of interest in pleasurable activities, lack of sleep (insomnia), loss of weight and lack of concentration, among others.

She adds that, going by the local standards, depression in the country has been catapulted by the increased orphanage rates, diseases, child abuse that involves the hard-hitting violence, absence/lack of basic needs and disease-. She also notes that there is a link between cross-generational depression in which the disorder is passed on from a pregnant mother to the unborn child.

“Depression in pregnant mothers is a common profound problem of which many don’t get any help, something that puts their unborn children at risk.

“A depressed mother, particularly as a result of violence, will give little care to her child who will grow up depressed and the story will go on,” Dr Abbo noted, pointing to the increased suicidal tendencies amongst children, particularly the adolescents. In most cases, the behaviour of depressed children and teenagers may differ from the behaviour of depressed adults.

A recent multi-country study conducted by the World Health Organisation (WHO) found that up to 71 per cent of women aged 15 to 49 years reported physical and/or sexual violence at some point in their lives. Violence against women has become a vicious cycle in families thus creating cross generational dysfunction.

Gloria Abura, a psychology scholar, points to the studies recently done, showing that one can be genetically predisposed to acquiring depression.

But nonetheless she notes that, one’s predisposition to acquiring depression does not necessarily mean that they will acquire it. It is not certain because a lot of factors must come into play, say an individual’s personality, the environment in which they are in and how vulnerable they are. This will all determine whether one gets depressed or not.

Speaking at the 2012 World Health Mental Day, Dr Margaret Mungherera, Senior Consultant Psychiatrist at Mulago hospital said, depression was fast growing in children, a fact unnoticed by parents yet in its advanced stages it results into a serious mental disorder.

Marking the day brought together a team of medical psychiatrists who urged government to put emphasis on funding for mental health, which seems neglected yet a significant number of people suffer mental related problems.

Ms Abura says, in most cases, depression goes undetected until it has probably progressed. “Sometimes it is the maladaptive ways of coping that alert the people around that something could be wrong. Parents and primary caregivers should endeavour to foster close relationships with their children.

“Know your child. Do not leave it all up to the teacher. Take time to talk to your children, develop relationships and build trust with your children so that they are comfortable enough to say ‘Mom, Dad, this and this happened…’”

She also said it would help if policy was put in place and followed that primary health care providers such as the school nurse, doctor or counsellor have basic training on depression and how to screen because it is a real problem.

About treatment of depression, Dr Joyce Nalugya, a senior child and adolescent psychiatrist ,speaking at the World Mental Day, maintained that in severe cases where symptoms cause clinically significant distress or impairment in social, academic and other important areas of functioning, parents should immediately seek psychiatrists for evaluation and treatment.

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